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Events Registration Form

Note: Please complete a separate form for each event you would like to attend

Name of event you wish to book for:
Where did you hear about this event?
If you are booking places for a workshop, seminar, conference or congress, please provide name and contact details for each individual delegate where indicated below. If you are booking places for the Fleet Safety Forum Awards, you do not need to provide names of all attendees at this stage; we will contact you for this information. To get the discounted table price, you must book at least 10 tickets.
How many places would you like to book?
Name of organisation*:
Job title*:
Title*:
First name*:
Surname*:
Address for invoicing*:
Postcode*:
If you would prefer to pay by credit card please tick here and we will be in contact with you to take the details:
Email*:
Daytime Tel*:
Delegate 1 name, daytime phone number and email address (if different from above):
Delegate 2 name, daytime phone number and email address:
Delegate 3 name, daytime phone number and email address:
Are any of the delegates subscribers to Brake?
If so, which Forum do they subscribe to?
Would you like to take up the offer of a year’s free subscription to one of Brake's professional subscription schemes? (offer applies to full paying delegates, who are not already subscribers, at Best of the Best Conference, Speed Congress, Child Bereavement Seminars, Pledge2DriveSafely workshops and 2Young2Die workshops)
We regret that if cancellations are made less than three weeks prior to any event, no refunds can be made or invoices cancelled, and the full rate will be payable. Substitute delegates are welcome. All substitutions and cancellations must be made in writing. Tick here to confirm that you understand and accept our cancellation policy.
We will not give your details to others and will only send you future information about Brake and its activities. Tick this box if you do NOT want to hear from Brake again.
Please enter the code in the box below